CONSIDERABLE STRIDES HAVE been made over the last 30 years in reducing child malnutrition but the situation is still grim. In the South, one out of three children under five is still undernourished and, as a result, is more susceptible to disease and early death and more likely to experience poor cognitive development. As they grow to adulthood, these children are likely to be more prone to chronic disease, to be less productive and to give birth to undernourished children themselves. This report analyzes data from 63 countries to determine the causes of malnutrition, to make projections for the future and to identify priorities for action.
The report does not focus on the immediate causes of malnutrition, i.e. inadequate dietary intake and poor health, but on factors responsible for these immediate causes. It distinguishes between underlying determinants (food security, care for women and children, and environmental health ) and basic determinants (larger economic resources and the political environment). These determinants are, in turn, represented by variables that are either easier to measure or for which cross-country data is more readily available. The underlying determinants, then, are represented by national food availability, women's education and their status relative to men (based on life expectancy), and access to safe water.
The basic determinants are represented by per capita national income and the presence of democracy (a combined measure of political rights and civil liberties).
The authors acknowledge the limitations inherent in some of these representations, most significantly the absence of cross-national data for poverty and food security at the household level. National food availability is necessary to household-level food security but not sufficient to ensure it. The study found that the most significant overall determinant of reductions in child malnutrition has been increases in per capita national income, which has been responsible for roughly 50 per cent of the total reduction between 1970 and 1995. (Democracy, by contrast, has made no contribution, largely because there has been no progress in this area for these 63 countries as a whole). The increase in national
incomes has, in turn, been important for its capacity to facilitate investment in the underlying determinants: improvements in the level of women's education are thought to be responsible for 43 per cent of the reduction in child malnutrition – rising to over 50 per cent if women's relative status is included, improvements in food availability for 26 per cent and access to safe water for 19 per cent. The report discusses how the relative importance of these factors varies from one region to another – for instance, in sub-Saharan Africa, safe water access has been more important than in other regions; in East Asia and the Near East and North Africa, food availability has been relatively more important.
The report projects for the future that child malnutrition will remain high – anywhere from 15 to 22 per cent depending on whether more or less optimistic scenarios are assumed. Most disturbing is the fact that, even under the most optimistic scenario, sub-Saharan Africa is projected to have more more malnourished children in 2020 than it did in 1995. The report suggests, however, that more significant progress could be made through increased attention to areas that have not been a traditional focus for nutritional interventions, viz. the underlying variables in this study. Priorities would vary by region, as the causes do. The most significant problems do not necessarily determine priorities. Cost-effectiveness would also have to be an important factor. For instance, if it costs more than 2.8 times as much to increase secondary education for girls by one per cent than to increase safe water access by one per cent, then the latter would become a more reasonable way of reducing malnutrition.
Finally,